Applied Geography 35 (2012) 405e413

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Applied Geography
journal homepage: www.elsevier.com/locate/apgeog

Child malnutrition and climate in Sub-Saharan Africa: An analysis of recent trends in Kenya
Kathryn Grace a, b, *, Frank Davenport a, Chris Funk a, c, Amy M. Lerner d
a

University of California, Santa Barbara, Department of Geography, USA Department of Geography, University of Utah, Salt Lake City, UT, USA c United States Geological Survey (USGS) e Earth Resources Observation and Science (EROS), USA d Rutgers University, Department of Geography, USA
b

a b s t r a c t
Keywords: Climate Kenya Malnutrition Stunting Food security

In Kenya e where undernutrition rates are high and the population-environment balance is delicate e the risk of declining food availability has become increasingly concerning as indications of drying trends threaten current food systems. The purpose of this research is to determine if climate variables are related to rates of childhood stunting in Kenya. Specically we use multi-level regression models at the cluster/household level to evaluate the correlation between surface temperatures, rainfall levels and stunting among children aged one to ve. Our results suggest that as Kenya continues to experience warming and drying, malnutrition rates will increase. We propose that investments in infrastructure and expansion of education can mitigate the negative impacts of climate change. 2012 Elsevier Ltd. All rights reserved.

Introduction Many countries within Sub-Saharan Africa, where food production is often affected by environmental conditions (i.e. soil fertility, rainfall, temperature), face the risk of declining food availability as indications of warming climates threaten current food systems (Brown & Funk, 2008; Funk & Brown, 2009). Among these countries Kenya (along with the countries of the greater Horn) shows high potential for extreme climate events under climate change scenarios (Funk et al., 2008). Approximately 30% of Kenyas children between one and ve years old are reported as stunted (a commonly used indicator of chronic undernutrition or malnutrition) (KNBS, 2010; FAO, 2009). Climatologists have also determined that Kenya is experiencing increases in average annual temperatures and decreases in growing season rains (Funk et al., 2010; Williams & Funk, 2010). The combination of these climate factors leads to increasing strains on food resources as the land area suitable for planting and agricultural production is decreasing (Funk et al., 2008, 2010). By reducing the area suitable for cultivation, climate change may be exacerbating food shortages and may therefore lead to an increase in child malnutrition.

* Corresponding author. Department of Geography, University of Utah, Salt Lake City, UT, USA. E-mail addresses: grace@geog.utah.edu (K. Grace), davenport@geog.ucsb.edu (F. Davenport), cfunk@usgs.org (C. Funk), amy.lerner@rutgers.edu (A.M. Lerner). 0143-6228/$ e see front matter 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.apgeog.2012.06.017

Negative health outcomes among children, particularly stunting, are a common result of food insecurity. When a childs natural growth trajectory is negatively impacted because his nutritional and caloric needs are consistently unmet, his growth slows and the likelihood of him completing secondary school and obtaining wage-earning employment decreases (Alderman, Hoddinott, & Kinsey, 2006; Jamison, 1986). Additionally, when women are malnourished as children they may be more likely to experience complications during delivery of their own children and deliver lower birth-weight babies (Alderman et al., 2006; Strauss & Thomas, 1998). The impact of malnutrition therefore has negative ramications for a populations health and development in both the short- and the long-term. While the relationship between childrens health, landscape, and geophysical variables has been evaluated in a few recent studies (Balk, Storeygard et al., 2005; Dos Santos & Henry, 2008; de Sherbinin, 2011), no recent study has explicitly evaluated climate variables at the household level. However, because food is often produced within a relatively small distance from a rural household, examining the role of precipitation and temperature at this level is necessary to fully understand the impact of climate on childrens health. The purpose of this research is to determine if climate variables are related to rates of child hunger in Kenya. Specically we will evaluate the correlation between surface temperatures and rainfall levels on the rates of stunting (a primary indicator of child malnutrition) among children aged one to ve. The inclusion of the climate data into this analysis serves two purposes: 1) to evaluate

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the correlation between climate variables and child malnutrition at the household-level and 2) to determine if warming and drying trends are linked to higher rates of malnutrition. Linking climate change and malnutrition in Kenya The denition of household food security has moved from primarily an issue of food availability to a result of food access (Sen, 1981) and more recently an outcome of political and social factors (Devereux & Maxwell, 2001). According to the World Food Summit and the Food and Agriculture Organization, the three core aspects of food security include: 1) availability, 2) access, and 3) utilization (FAO, 2006). Despite the fact that current food security policy mostly focuses on access, the availability of food is still a fundamental component of food security. Moreover, because the actual availability of food can be largely impacted by agricultural production, variation in food availability can be linked to climate patterns. Climate patterns, namely rainfall and temperature, are increasingly variable with the onset of global climate change, and therefore the relationship between agricultural production and climate is of increasing attention and concern (Lobell & Field, 2007). One important component of national food availability in the developing world is food production or crop yield (Frankenberger et al., 1997; Smith, El Obeid, & Jensen, 2000; UNICEF, 1998). Recent research (Battisti & Naylor, 2009; Lobell et al., 2008) has highlighted the potential for major country-level food production changes as a result of decreased rainfall and increased temperatures or climate change. A particularly compelling example provided by Battisti and Naylor (2009) highlights the impact of the 2003 summer heat wave in Europe. Their results state that because of the increased temperatures, the mean temperature was 3.6  (Celsius) higher than the long-term mean, livestock were stressed, agricultural water use increased and maize and fruit productions decreased by 21%e36%. Given that countries in East Africa, Kenya among them, have experienced (and are expected to continue to experience) increasing temperatures and decreasing rainfall (Williams & Funk, 2010), concern about the impact of these climatic events in Africa on food production is high (Battisti & Naylor, 2009; Lobell et al., 2008). The focus on food availability and climate for the purposes of this paper is directed at to two main outcomes: national supply of food that households procure through markets, and household production of food in rural areas for subsistence. Therefore, our analysis targets rural households with agriculturally-based livelihoods that would be directly impacted by climate variability through shifts in agricultural production, both for household subsistence and sales in markets. The denition of livelihood employed here is taken from the Famine Early Warning Systems Network (FEWS NET), which is the means by which households obtain and maintain access to essential resources to ensure their immediate and long-term survival (see www.fews.net). Access to essential resources, such as cash and food, is based on a variety of factors, including physical and social assets (i.e. land and labor), geography (where households are located), and social networks. From this denition of livelihoods, FEWS NET employs the Household Economy Approach to assess food security by identifying potential household vulnerabilities and coping mechanisms in the face of a natural hazard (Seaman, Clarke, Boudreau, & Holt, 2000). In order to assist in determining food insecurity in the face of natural hazards (i.e. drought), FEWS NET creates maps of livelihood zones (see Fig. 3), where households share similar methods of acquiring food, income, and other essential resources. The conceptual relationship among climate variables, food availability, and food insecurity is given in Fig. 1. This gure also serves as an overview of the analytical framework that guides our

Fig. 1. Conceptual link between temperature, precipitation, and child stunting.

empirical model specication. At the top of the gure is child stunting, a common measure of household food insecurity (described in greater detail below). In addition to basic physical determinants, child stunting can manifest as a result of insufcient utilization, availability, or access to food (the three components of food security). We propose that temperature and precipitation impact food production which in turn impacts food availability. However, because the dominant livelihood strategy varies across Kenya, with some areas being more dependent on rainfall than others, the degree of inuence that climate variables have on food production will vary. Figs. 2 and 3 highlight the climatic and livelihood variation across Kenya. Fig. 2 shows the observed and projected precipitation and temperature trends for the period 1975 through 2025. In both panels of that gure darker colors indicate areas that have experienced persistent patterns of warming and drying. Fig. 3 presents a map of the Kenya livelihood zones as delineated by the FEWS NET project. There are several areas, especially in the Northern and Eastern regions of the country where pastoral and marginal farming areas overlap with areas of observed or projected warming and drying. It is in these regions where we expect food production, and thus child malnutrition, to be most correlated with precipitation and temperature. With this framework in mind, we examine the most recent Kenyan Demographic and Health Survey data (KDHS) and climate data from 1998 to 2008 to evaluate one outcome of food insecurity, child malnutrition. Our analysis examines child stunting (a measure of chronic malnutrition) across Kenyan communities with a specic focus on the impact of climate variables (rainfall and temperature) as a component of food availability. The results of this

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Fig. 2. Observed projected changes in Kenyan rainfall and air temperatures. Source: Own calculations (see Funk et al. (2011) for details on data).

analysis will provide empirical evidence of the impact of climate and climate change at the micro-scale and contribute to expanding research evaluating health and climate change. Data We rely on two types of data for this analysis e 1) demographic/ health data and 2) climate data. Demographic/health data The demographic data come from the 2008 Kenya Demographic and Health Survey (KDHS). In addition to child-specic anthropometric measures, these data also contain household and parental information that has been correlated with child stunting. Our dependent variable is the height1 for age Z-scores (HAZ) of children between one and ve years old. The HAZ is a standard measurement of child stunting and is commonly used as a measure of chronic child malnutrition (Balk et al., 2005; Kwena, Terlouw et al., 2003; Sahn & Stifel, 2002; WHO, 2004; WorldBank, 1995).2 The relationship between the HAZ score, child stunting, and malnutrition is dened by WHO Multicenter Growth Reference Study (MGRS) (WHO, 2004)3 and summarized here: Children more than two standard deviations (HAZ  2) from the reference

1 Length is used for children <24 months, height for children >24 months WHO (2004). The WHO Multicenter Growth Reference Study (MGRS), World Health Organization. 2 Height for age is the preferred measure of chronic malnutrition because it less likely than other indicators to be impacted by disease or other sources of stress when the data is collected. For example Sahn and Stifel (2002) note that height for age, unlike weight, will not be impacted by temporary ailments such as diarrhea or malaria. 3 For general information on the MGRS, see: http://www.who.int/childgrowth/ mgrs/en/.

height-for-age ratio for their age group are classied as stunted, while those with a HAZ  3 are considered severely stunted. Stunting occurs as a result of caloric deciency or improper nutrients (unhealthy diet) either before or after birth.4 Thus stunted children generally suffer from malnutrition while severely stunted children suffer from severe malnutrition. In this paper we focus on children between the ages of 1 and 5 years old because height for age at this growth period is generally assumed to be independent of racial, ethnic, and socioeconomic status (WHO, 2004). Independent variables in this paper are selected to control for biological determinants of malnutrition as well as household and parental characteristics accounting for food access. We incorporate biological controls including the childs age, sex, and if the child is a twin or not. We also adjust for the length of time the child was breastfed and the childs size at birth (as reported by the mother). Among the parental characteristics we include the mothers age, education level, and height. We include several household variables that have been shown in other contexts to explain variation in food access. Specically, we include categorical variables accounting for household water source and oor material (Balk et al., 2005; de Sherbinin, 2011). Using aggregated categories from the KDHS dataset each household is characterized as receiving their water via pipes, wells, surface water bodies or by other means (this category includes the small set of households who rely on bottled water, tanker trucks or gathering rainfall as the household water source). A households ooring is identied as either nished (tile, wood, cement) or unnished (dirt). Both of these variables have been useful in related studies of

4 Children age 0e3 with high height for age ratios (>2) are generally considered healthy which, after controlling for parental genetics, is the result of a wellbalanced and nutritious diet (i.e. not too little food, not too much food, and a proper diet). However there is some research that shows that children who grow exceptionally fast between age 0e3 might exhibit a propensity for obesity later in life Baird, Fisher et al. (2005).

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Fig. 3. Livelihood zones and regions of Kenya. Livelihood Zones data available from FEWS NET.

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household health and malnutrition. While somewhat dependent on local and available natural resources, a households water source also reects the potential exposure of the household to illness. Well and piped water are anticipated to provide the most consistently sanitary water while households that rely on surface sources to meet their water needs are likely to cope with inconsistent or unsanitary water. Flooring is used as an indicator of household wealth and have been signicant in related analysis of food insecurity (Balk et al., 2005; Bloss, Wainaina et al., 2004). Livelihood zone information is included, as highlighted earlier, to reect climatic sensitivity at a more macro-level. This data is gathered from FEWS NETs recent efforts to classify the dominant livelihoods of some developing countries throughout the world. FEWS NET relies on local experts and international scientists who incorporate the local environment and the economic market to construct livelihood information and this data has been used to isolate areas within a country that are the most vulnerable to hunger (Grace, Husak, Harrison, Pedreros & Michaelsen, 2012; Husak, Marshall et al., 2008; Marshall et al., 2011). Because these zones represent different strategies by which households and individuals generate income and food, some more dependent on climate factors than others, we anticipate that the climate variables will have differing impacts depending on the livelihood zone. Fig. 3 presents the Kenyan livelihood zones (along with political regions) as delineated by FEWS NET and used in this analysis. Climate data Climate data are interpolated from a combination of ground based meteorological stations, remotely sensed data, and a priori knowledge of climatic patterns within that region (Funk et al., 2011). For a given season (MarcheJune in this study), station observations of rainfall and temperature are used to calculate the 1960e1989 means and 1960e2009 trends. Moving window regression models and geostatistical interpolation are then used to transform the at-station point observations to 0.1 grids. Elevation, mean satellite observed rainfall, mean satellite observed land surface temperatures, and mean satellite-observed brightness infrared temperatures are used to guide the interpolation process. The gridded mean and trend elds are then used to produce an observed 1990e2009 mean eld, and projected 2010e2039 mean elds. If the recent drying and warming in east Africa is linked to quasi-linear temperature increases in the Indian Ocean (Funk et al., 2008; Williams & Funk, 2010), then a short term linear projection may be realistic. The long term mean elds were also used in conjunction with monthly station data to produce seasonal MAMJ (MarcheAprileMayeJune) rainfall estimates for each year between 1900 and 2009. This data represents the most up-to-date data for this region. Climate factors are represented by rainfall and temperature variables that capture the climate patterns over each childs lifetime. We calculate total rainfall for the growing season for each year of the childs life and average those values over the life of each child (therefore each child is attributed with one rainfall value representing growing season rainfall over his or her lifetime). We do a similar calculation for temperature, but use the average temperature (as opposed to the total rainfall) over the growing season, and then average these values over the life of the child. Similarly, the variation in temperature and rainfall during the growing seasons are also calculated and included in the analysis. Based on the food security framework applied here we anticipate that larger rainfall values will be associated with higher (i.e. healthier) HAZ scores and that temperature will be negatively associated with HAZ. We also anticipate that greater variability in rainfall and temperature will be correlated with lower HAZ scores as inconsistent rainfall and

temperature may inhibit crop production. Of course, we anticipate that the relationship between climate and HAZ may be impacted by the dominant livelihood strategy of the area surrounding each childs household. Merging climate and KDHS One of the unique contributions of this analysis is the use of climate variables in combination with household- and individuallevel variables. Because the KDHS contains geo-referenced households the climate data are linked to households based on the location of the KDHS sampling cluster (clusters contain approximately twenty households) where the child resides. KDHS records the geographic location of the center of all clusters where surveys were administered. To protect the privacy of respondents, urban clusters are randomly shifted by 2 km, rural clusters by 5 km, and 5% of all clusters shifted by 10 km. We account for the location shift by aggregating climate data both in and around the community cluster location. Specically we attribute households with climate data for an approximate 10 square kilometer grid cell e including where the cluster lies, and all grid cells congruent to the cluster grid cell (see Fig. 4 above). Attributing the cluster grid cell with the climate information of itself and its neighbors accounts both for the location shift and the fact that rainfall and temperature outside of a households immediate area may still inuence that households ability to meet the caloric and nutritional requirements of its members. One of the key assumptions in our analysis is that a childs HAZ score is a function of food and water availability in the area surrounding each childs community. This assumption becomes more tenuous for children living in densely populated metropolitan areas where food access and availability are likely dependent on imported products and less dependent on climate. Because KDHS

Fig. 4. Visualization of climate data aggregation. Note: This gure conceptually demonstrates how environmental variables were joined with KDHS sampling clusters. The point in the middle represents the sampling cluster. The blue ring with marks surrounding the cluster represents a 13 km search buffer. The highlighted squares represent all grid cells that fall within that buffer. Precipitation and temperature values were averaged over these grid cells. (For interpretation of the references to color in this gure legend, the reader is referred to the web version of this article.)

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only provides general information on rural and urban type of residence and not specic information about the size of the urban areas e we rely on external data to identify the most densely populated urban areas. The Afripop5 (Tatem et al., 2007) dataset provides additional information on population density which we rely on to lter out children in the most population dense areas (areas with more than 500,000 people). Afripop is a 100 m resolution gridded estimate of population density for the African continent. The product uses both census and remotely sensed data to estimate populations within grid cells. We calculate the population density of a childs surrounding area using the same aggregation technique used for merging the climate and KDHS data. We then analyze the remaining sample and include the rural/urban information to sort out the smaller urban communities (smaller villages and community groups) from the most rural households. Methods To determine if child hunger at the micro-level is impacted by climate variables we construct a multi-level linear regression model with HAZ as the response variable. Reecting the hierarchical nature of the survey design strategy employed by KDHS we nest households within KDHS clusters in the regression model. The multilevel model enables us to model HAZ (at the household-level) while accounting for systematic unexplained variation among the 320 clusters. A growing body of research suggests that models that incorporate this type of hierarchical structure improve the ability of the regression model to identify signicant relationships between the response and independent variables. (For more information on the use of multi-level models see Gelman, 2006 and Gelman & Hill, 2006 and many others.) We construct several models with different variable specications to help isolate the impacts of the climate variables after taking into account the variation in HAZ that results from individual- and household-level factors.

Results The 320 KDHS sampling clusters contain 2255 children. The clusters are dispersed throughout the 20 livelihood zones (Table 1) with the largest concentration found in the Western High Potential zone and the smallest in the Riverine Zone. The average HAZ of the livelihood zones is diverse. The highest levels of stunting are found in the Southeastern Medium Potential, Mixed Farming zone (HAZ 2.2) while the highest average HAZ value is found in the Grasslands Pastoral Zone (HAZ 1.1). A notable diversity in rainfall and temperature values by livelihood zone is also apparent. The Northwest Pastoral Zone reports the lowest average as well as the highest temperature value. The Western High Potential Zone reports the lowest temperature value (more than 10  C lower than that of the Northwest Pastoral Zone) and the Western Lakeshore Marginal Mixed Farming Zone reports the largest average rainfall values (almost 500 mm more than the Northwest Pastoral Zone). The next stage of our analysis incorporates both livelihood zone and the climate variables into the analysis of HAZ scores to further examine the relationship between the varying climate conditions and the variation in HAZ throughout Kenya. The results of the analysis are presented in Tables 2 and 3. We constructed four primary models e Model 1 serves as our baseline model and includes the individual, maternal and household level variables that have been linked to child stunting in related research and primarily serve as control variables here. In this model we also include the livelihood zone. Models 2a and 3a contains the climate variables e precipitation and temperature, respectively e in addition to the variables included in Model 1. Models 2b and 3b are identical to Models 2a and 3a with the exception that precipitation and temperature variation are included in place of mean climate values. Because of high correlation between the means and standard-deviations of the climate variables these variables are not included in the same models. In each of the models, we account for

yij aj bk xij ij aj g0 g1 cj hj

(1)

Table 1 Climate and population density by livelihood zone. Livelihood zone Central highlands, high potential zone Coastal marginal agricultural mixed farming zone Coastal medium potential farming zone Grasslands pastoral zone Lake victoria shing zone Mandera riverine zone Northeastern agropastoral zone Northeastern pastoral zone Northern pastoral zone Northwestern pastoral zone Southeastern marginal mixed farming zone Southeastern medium potential, mixed farming zone Southeastern pastoral zone Southern agropastoral zone Southern pastoral zone Tana riverine zone Western agropastoral zone Western high potential zone Western lakeshore marginal mixed farming zone Western medium potential zone Cluster count 360 167 127 42 84 15 25 95 29 15 111 51 HAZ 1.43 1.81 1.38 1.11 1.14 1.69 1.32 1.78 1.48 2.13 1.84 2.22 Temperature ( C) 21.47 27.27 27.5 30.48 21.55 30.99 25.6 29.96 26.85 31.71 26.28 25.05 Rainfall (mm) 539.11 390.06 437.99 166.31 649.17 142.01 312.24 176.82 253.53 156.83 350.91 415.77

Equation (1): Multilevel Model with Random Effects. In Equation (1), i indexes individuals (and households) while j indexes sampling clusters. The dependent variable yij is an N 1 vector of HAZ scores indexed by individuals and clusters. The covariates are included in xij and while aj is a cluster level random intercept coefcient. The errors (i) with variance, s2y, represent variations within the sample clusters. These variations include includes measurement error (surveyor error), natural variation in malnutrition levels and variation between households (beyond what is explained by the independent variables used in the model). Because the climate variables are dependent on the location of the cluster where a child lives, there is the possibility of correlation between the individual-level precipitation and temperature variables and the community cluster error (hj). To accommodate this potential correlation we follow Bafumi and Gelman (2006) (see also Skrondal & Rabe-Hesketh, 2004, pp. 52e53) and incorporate the mean precipitation and mean temperature values at each cluster into the model at the cluster-level. The intuition behind this approach is as follows: by placing the group level mean term in the second level of model, we remove the principal source of correlation among the individual level term and the group level error. The group level mean is represented by the second term (cj) in the second line of Equation (1).

58 52 26 10 70 585 268 78

1.75 1.7 1.65 .48 1.74 1.6 1.52 1.49

29.14 21.01 22.99 30.78 22.97 20 21.45 21.56

299.91 512.13 351.33 170.82 277.65 616.21 648.87 406.5

http://www.clas.u.edu/users/atatem/index_les/AfriPop.htm.

K. Grace et al. / Applied Geography 35 (2012) 405e413 Table 2 Regression results by livelihood zone. Variable Livelihood Coastal marginal agricultural mixed farming Coastal medium potential farming Grasslands pastoral Lake victoria shing Mandera riverine Northeastern agropastoral Northeastern pastoral Northern pastoral Northwestern pastoral Southeastern marginal mixed farming Southeastern medium potential mixed farming Southeastern pastoral Southern agropastoral Southern pastoral Tana riverine Western agropastoral Western high potential Western lakeshore marginal mixed farming Western medium potential Climate Precipitation (mm) Variance in precipitation Temperature ( C) Variance in temperature AIC Note: Bolded values indicate signicance at p  .1. Model 1 .0645 .1435 .5457 .2472 .1596 .271 .1234 .1844 .5112 .213 L.6129 .0311 .0473 .0454 .7983 .1031 .0559 .0338 .0672 Model 2a .0517 .2078 .8163 .1663 .12 .4292 .1255 .3858 .239 .0748 L.5044 .1361 .0272 .0932 1.0596 .0852 .1087 .0459 .1648 .0007 .0006 .0385 .0878 8407 8420 8420 8413 8412 Model 2b .0409 .1518 .5878 .2515 .1207 .2963 .0975 .2045 .4815 .1934 L.5702 .0136 .0393 .0182 .8311 .086 .0479 .0359 .0811 Model 3a .1638 .381 .8966 .2474 .2083 .4239 .1936 .3961 .1261 .0311 L.471 .2513 .066 .0067 1.1595 .0458 .1139 .0291 .0679

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Model 3b .0408 .1816 .5907 .2804 .138 .3102 .0843 .1768 .4639 .2152 L.6097 .0087 .0187 .0437 .8517 .1207 .0157 .0519 .0466

the hierarchical nature of the survey design by nesting HAZ scores within the cluster where the household is located (using a multilevel model as outlined in the methods section). Our results highlight the signicance of education, water supply, and oor type, as well as livelihood zone and precipitation. Our baseline model shows strong positive impacts for the mothers education, oor type and water supply. Our model also indicates that depending on the dominant livelihood strategy of the surrounding area, HAZ rates will vary. Children living in the Grasslands Pastoral and Riverine Zones record statistically higher HAZ than children in the central highlands (the baseline category and the area representing the grain-basket of Kenya). Children living southeast of the central highlands in the Southeastern Medium Potential, Mixed (livestock, cash crops and subsistence) Farming zone report signicantly lower HAZ scores than their

counterparts in the high producing Central zone. This drought prone, densely populated area directly southeast of the capitol city (Nairobi) has the highest observed level of stunting. It is also worth noting, that after removing the individuals living in the most dense urban areas (>500,000 people) in our sample, the rural versus urban distinction appears weak. Even after accounting for the variation in HAZ due to the dominant livelihood strategy in the area of residence, there is a signicant impact from precipitation on the HAZ of children between 1 and 5 years old in Kenya (we believe that the high correlation between the two variables makes their joint inclusion in a model questionable as they likely explain similar variation in malnutrition). When we construct one model for each of the climate variables, models 2a and 3a, the positive relationship between rainfall and HAZ are clear while temperature appears to

Table 3 Regression results by demographic characteristics. Variable Personal Age (months) Breastfed (6e11 months) Breastfed (12 or more months) Fever in past two weeks (yes) Child size at birth (average) Child size at birth (large) Twin (yes) Sex (male) Mothers age Mothers height Household Floor material (nished) Water source (well) Water source (other) Water source (piped) Mothers education (primary) Mothers education (secondary and beyond) Urban (urban) Model 1 .0005 .0795 .1436 .0381 .3348 .5826 .4193 L.2177 .0031 .0239 .2004 .0691 .3247 .2298 .1329 .3053 .0131 Model 2a .0003 .0778 .1488 .0357 .3384 .5792 .4391 L.2204 .0031 .024 .2019 .0809 .3188 .2296 .1311 .3035 .0056 Model 2b .0002 .0804 .1455 .0346 .3326 .5788 .4317 L.2193 .0031 .0239 .2001 .0683 .3196 .2276 .1301 .3051 .0101 Model 3a .0006 .0754 .1504 .0287 .3413 .5932 .4208 L.2199 .0029 .0238 .1994 .0638 3165 .2252 .1302 .2997 .0147 Model 3b .0003 .0807 .1469 .0379 .3368 .5852 .4194 L.217 .0032 .0238 .1984 .0687 .314 .2192 .1328 .3042 .0095

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have no signicant impact on HAZ variation. This suggests that as Kenya experiences drying, regardless of changes in temperature, we can anticipate greater incidence of child stunting. Variation in precipitation and temperature (models 2b and 3b) however, are not correlated to HAZ. Together these results suggest that the level of precipitation, rather than precipitation variability, impact chronic malnutrition of young Kenyan children. In addition to precipitation, water source, oor type and womens education also have a signicant impact on HAZ. Moreover, these variables remain signicant with very little change to the magnitude of the coefcients across the differing model specications. Children in households where the principal water source is not surface-water sources have higher HAZ scores even after adjusting for precipitation and differing livelihood strategies. Likewise, children who live in households with nished ooring (as opposed to dirt ooring) have higher HAZ scores than their counterparts who live in houses with dirt oors. Similarly, children with mothers who have completed primary or secondary school have signicantly lower levels of stunting than those with mothers who have less schooling. Discussion The goal of this research was to evaluate the relationship between climate variables and child malnutrition using a food security framework. This framework identies access to and availability of food as the primary determinants of food insecurity and, by extension, child stunting. In our analysis we focused on precipitation and temperature as the major determinants of food availability in rural areas/agriculturally-based households and sought to quantify the relationship between these two climate variables and stunting among the youngest members of the Kenyan population. The strength of our approach was that the climate variables, rainfall and temperature, were incorporated into the analysis of child malnutrition with attention to where the child lived as well as the age of the child. While merging health and geophysical data at relevant spatial and temporal scales is vital to ensure an adequate analysis of the relationship between household health and climate, there are very few studies that adopt this approach. In general, our results indicate that precipitation level has a signicant effect on child stunting. These results are in line with related work on micro-level child health and the environment (Dos Santos & Henry, 2008) although they do differ from more macrolevel studies of child hunger and the environment (Balk et al., 2005). We assume that the differences in results as compared to the work of Balk et al. (2005) stem from our use of ner scale precipitation data. Additionally, we determined that precipitation variability is not a signicant explanatory variable. This nding is notable as precipitation variation is one of the important components of climate change and yet had no notable relationship with chronic hunger in the study context. Furthermore, the fact that the relationship between temperature and child stunting is not signicant suggests that, in this context, precipitation level may be of most importance in terms of child malnutrition rather than other measures of climate change. Research examining the main correlates of cultivation has similarly indicated the importance of seasonal precipitation as opposed to temperature or precipitation variation (Grace et al., 2012). Our results are therefore consistent with the use of ne scale seasonal precipitation to serve as an indication of local food production. Other household characteristics yielded expected results in terms of child stunting. Households where the mother had higher education levels tended to have lower incidents of child stunting, which is consistent with other studies on education and food security (Dos Santos & Henry, 2008; Balk et al., 2005; de Sherbinin,

2012). Additionally, households that rely on surface water also had higher incidence of stunting, indicating that surface water sources may be more vulnerable to drought. Not surprisingly, households with non-dirt oors, indicating higher wealth, were associated with lower rates of stunting. While it is difcult to draw rm conclusions from potentially endogenous variables like water source and oor material, it is clear that overall, wealthier, more educated households had lower incidences of stunting regardless of livelihood type and region. The associations between malnutrition and water-source, malnutrition and oor type and malnutrition and education are not new, however, the fact that they remain signicant in the presence of climate and livelihood adjustments is notable and suggests potential lifestyle changes (specically expanding and improving womens education and changing household water use practices) could be made to combat the impacts of a drying and warming climate in Kenya. Investments in improved water delivery infrastructure could substantially reduce malnutrition. In sum, investments made to ensure that all households have access to culturally relevant and nutritional food will contribute to the long term health of Kenya and this investment is especially important in the presence of a drying climate. Conclusion Kenya has experienced dramatic population growth, increasing rates of child malnutrition and signicant warming and drying in the past quarter century. A reduction in arable land caused by increasing temperatures and decreasing rainfall will likely contribute to greater stress on natural resources. As most poor people outside of the major urban areas depend on locally grown, easily available and affordable food, reduced natural resources will lead to a reduction in food availability which will eventually inhibit or even reverse positive strides in health and development. Our results link variables within a context of a changing climate to child stunting and suggest that climate change could indeed increase stunting rates in areas of the country dependent on rainfed agriculture. However, by evaluating individual, household and climate factors together, the results of this study suggest that there may be strategies to reduce the negative impact of reduced rainfall. Social factors, amenable to policy and governance, appear more important than climate suggesting that human health is primarily a function of human society. Climate and climate change play an appreciable role, but mitigation through improved education and social services seems particularly salient. And while this project provides important evidence of the importance of examining household malnutrition and local climate characteristics, future qualitative research is needed to further examine the mechanistic link between maternal education and child malnutrition and household wealth and child malnutrition. Acknowledgments We are grateful for the assistance and support of Dr. Greg Husak. This work was supported by the Famine Early Warning Systems Network (FEWS NET) and USGS award #G09AC00001. An earlier version of this work was presented at the Population Association of America conference in 2011. References
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